Not Applicable
This invention relates generally to a method of treating malignancy-associated hypercalcemia (MAH), and in particular, to the use of active forms of vitamin D to reduce hypercalcemia associated with inhibit the hyperproliferative diseases.
Extensive research during the past two decades has established important biologic roles for vitamin D apart from its classic role in bone and mineral metabolism. Specific nuclear receptors for 1xcex1,25-dihydroxyvitamin D3, the hormonally active form of vitamin D, are present in cells from diverse organs not involved in calcium homeostasis. For example, specific, biologically active vitamin D receptors have been demonstrated in the human prostatic carcinoma cell line, LNCaP, (Miller et al., 52 Cancer Res. (1992) 515-520); Vitamin D receptors have also been described for many other neoplastic cells, e.g., carcinomas of the breast and carcinomas of the colon.
It has been reported that certain vitamin D compounds and analogues are potent inhibitors of malignant cell proliferation and are inducers/stimulators of cell differentiation. For example, U.S. Pat. No. 4,391,802 issued to Suda et al. discloses that 1xcex1-hydroxyvitamin D compounds, specifically 1xcex1,25-dihydroxyvitamin D3 and 1xcex1-hydroxyvitamin D3, possess potent antileukemic activity by virtue of inducing the differentiation of malignant cells (specifically leukemia cells) to nonmalignant macrophages (monocytes), and are useful in the treatment of leukemia. Antiproliferative and differentiating actions of 1xcex1,25-dihydroxyvitamin D3 and other vitamin D3 analogues have been reported with respect to cancer cell lines. More recently, an association between vitamin D receptor gene polymorphism and cancer risk has been reported, suggesting that vitamin D receptors may have a role in the development, and possible treatment, of cancer.
These previous studies have focused exclusively on vitamin D3 compounds. Even though these compounds may indeed be highly effective in promoting differentiation in malignant cells in culture, their practical use in differentiation therapy as anticancer agents is severely limited because of their equally high potency as agents affecting calcium metabolism. At the levels required in vivo for effective use as, for example, antileukemic agents, these same compounds can induce markedly elevated and potentially dangerous blood calcium levels by virtue of their inherent calcemic activity. That is, the clinical use of 1xcex1,25-dihydroxyvitamin D3 and other vitamin D3 analogues as anticancer agents is precluded, or severely limited, by the risk of hypercalcemia.
Hyperalcemia is frequently associated with malignancy (MAH), and is often a major contributor to morbidity and complicates clinical management of the malignancy. Parathyroid hormone related protein (PTHrP) is closely related to parathyroid hormone (PTH) and binds to the same receptor as PTH as well as other receptors. PTHrP is one of the main causative substances of such hypercalcemia, and is overproduced by malignant cells. 1,25-dihydroxyvitamin D3 has been found to repress the transcription of the PTHrP gene in cells, however, the 1,25-dihydroxyvitamin D3 compounds themselves increase serum calcium levels. Therefore a need exists for compounds with greater specific activity and selectivity of action, i.e., vitamin D compounds with antiproliferative and differentiating effects but which have less calcemic activity.
The present invention provides a method of treating malignancy-associated hypercalcemia (MAH) such as that associated with hyperproliferative cell growth and/or abnormal cell differentiation. The method includes use of active vitamin D compounds to treat hypercalcemia and reduce serum parathyroid hormone related protein (PTHrP) levels.
The foregoing, and other advantages of the present invention, are realized in one aspect thereof in a method of treating malignancy-associated hypercalcemia from the hyperproliferative activity of human neoplastic or hyperplastic cells, comprising treating the cells with an effective amount of a hypocalcemic hydroxyvitamin D compound having a hydrocarbon moiety substituted at the C-24 position on the sidechain of the molecule. The treating step includes inhibiting proliferation of, and inducing and enhancing differentiation in such cells.
A hydroxyvitamin D compound in accordance with the present invention is an active vitamin D and is suitably represented by the formula (I) described hereafter. Suitable compounds of formula (I) are 1xcex1,24-dihydroxyvitamin D2, 1xcex1,24-dihydroxyvitamin D4, 1xcex1,25-dihydroxyvitamin D4, 1xcex1,25-dihydroxyvitamin D2, 1xcex1-hydroxyvitamin D2 and 1xcex1-hydroxyvitamin D4.
The effective or therapeutic amount of the hypocalcemic hydroxyvitamin D compounds administrable in accordance with the present invention to patients in need on a daily basis per kilogram of body weight ranges from 0.01 xcexcg/kg/day to 2.0 xcexcg/kg/day.
In another aspect of the invention, lowering serum parathyroid hormone related protein (PTHrP) levels in patients suffering from hypercalcemia is accomplished by a method comprising, administering to these patients an effective amount of a hypocalcemic vitamin D compound, to lower the serum parathyroid hormone related protein (PTHrP) level.
The hypocalcemic vitamin D compounds are also valuable for the treatment of breast, prostate and colon cancer, as well as other neoplasms such as pancreatic cancer, endometrial cancer, testicular cancer, small cell and non-small cell cancer of the lung (including squamous, adneocarcinoma and large cell types), squamous cell of the head and neck, bladder, ovarian and cervical cancers, myeloid and lymphocyltic leukemia, lymphoma, hepatic tumors, medullary thyroid carcinoma, multiple myeloma, retinoblastoma, and sarcomas of the soft tissue and bone, i.e. neoplasms that express a vitamin D receptor.
In accordance with the present invention, when effective amounts of the hypocalcemic vitamin D compounds are administered to patients with MAH, significantly redeuced hypercalcemia is observed than is observed after the same amount of an activated vitamin D3 (e.g., 1xcex1-OH D3, 1xcex1,25-(OH)2 D3) is administered in previously known formulations. Thus, the compound in accordance with the present invention has an improved therapeutic index relative to active forms of vitamin D3 analogues.
Accordingly, another aspect of the invention is a method of treating malignancy associated hyercalcemia comprising administering to a subject who is suffering therefrom an effective amount of active vitamin D compound which has, or attains through metabolism in vivo, a vitamin D receptor (VDR) binding affinity substantially equivalent to the binding affinity of 1xcex1,25-dihydroxyvitamin D3 and has a hypercalcemia risk substantially lower that that of 1xcex1,25-dihydroxyvitamin D3, to normalize or reduce serum calcium levels.
For treatment for malignancy-associated hypercalcemia and the underlying malignant condition in accordance with the present invention, the active vitamin D is suitably administered alone as an active ingredient in a pharmaceutical composition, or is co-administered with an anticancer agent.
Further, included within the scope of the present invention is the co-administration of a hypocalcemic vitamin D compound with a cytotoxic or anticancer agent. Such agents suitably include antimetabolites (e.g., 5-fluoro-uracil, methotrexate, fludarabine), antimicrotubule agents (e.g., vincristine, vinblastine, taxanes such as paclitaxel, docetaxel), an alkylating agent (e.g., cyclophasphamide, melphalan, biochoroethylnitrosurea, hydroxyurea), platinum agents (e.g. cisplatin, carboplatin, oxaliplatin, JM-216, CI-973), anthracyclines (e.g., doxrubicin, daunorubicin), antibiolitics (e.g., mitomycin, idarubicin, adriamycin, daunomycin), topoisomerase inhibitiors (e.g., etoposide, camptothecins) or any other antineoplastic agents. (estramustine phosphate, prednimustine).
It is anticipated that the active vitamin D compounds used in combination with various anticancer drugs can give rise to a significantly enhanced cytotoxic effect on cancerous cells, thus providing an increased therapeutic effect. Specifically, as a significantly increased growth-inhibitory effect is obtained with the above disclosed combinations utilizing lower concentrations of the anticancer drugs compared to the treatment regimes in which the drugs are used alone, there is the potential to provide therapy wherein adverse side effects associated with the anticancer drugs are considerably reduced than normally observed with the anticancer drugs used alone in larger doses. Possible dose ranges of these co-administered anticancer agents are about 0.1 to 20 mg/kg/day.
Also included within the scope of the present invention is the co-administration of effective dosages of a hypocalcemic vitamin D compound in conjunction with administration of hormones or other agents, e.g., estrogens, which are known to ameliorate bone diseases or disorders. For example, prostate cancer often metastasizes to bone, causing bone loss and associated pain. Such bone agents may include conjugated estrogens or their equivalents, calcitonin, bisphosphonates, calcium supplements, cobalamin, pertussis toxin and boron.
In another aspect, the invention is a pharmaceutical composition which includes an anticancer agent which is an active hypocalcemic vitamin D compound; an agent selected from the group consisting of (i) an anticancer agent, (ii) a bone agent, and combinations thereof; and a physiologically acceptable carrier.
Other advantages and a fuller appreciation of specific adaptations, compositional variations, and physical attributes will be gained upon an examination of the following detailed description of preferred embodiments, taken in conjunction with the appended claims.
Not Applicable
The present invention provides an effective method for the treatment of hypercalcemia, i.e. unphysiologically high and deleterious blood calcium levels, associated with neoplastic and hyperproliferative diseases. Particularly, the present invention relates to therapeutic methods for ameliorating or alleviating the hypercalcemia associated with the hyperproliferative cellular activity of malignant and neoplastic diseases, as well as inducing, enhancing or promoting cell differentiation in the diseased cells. The present invention provides a novel treatment of a patient suffering from a hyperproliferative disease with an active hypocalcemic vitamin D compound. Preferably, the active vitamin D analogue is a hydroxyvitamin D compound and is suitably represented by formula (I) as described hereinbelow. The active vitamin D analogue is provided to the patient without itself causing dose-limiting hypercalcemia and hypercalciuria, and in fact, reduces the hypercalcemia caused by the malignancy. These attributes are achieved through specific chemical properties of the hypocalcemic vitamin D compounds as described.
In accordance with the present invention, when effective amounts of the hypocalcemic active vitamin D compounds are administered to patients with malignant diseases, the hypercalcemia is reduced, the PTHrP serum level is reduced, and the proliferative activity of the abnormal cells is inhibited, redeuced, or stabilized, and cell differentiation is induced, promoted or enhanced. Thus, the hypocalcemic vitamin D compounds of the present invention have an improved therapeutic index relative to active forms of vitamin D3 analogues.
It is known that vitamin D3 must be hydroxylated in the C-1 and C-25 positions before it is activated, i.e., before it will produce a biological response. A similar metabolism appears to be required to activate other forms of vitamin D, e.g., vitamin D2 and vitamin D4. Therefore, as used herein, the term xe2x80x9cactivated vitamin Dxe2x80x9d or xe2x80x9cactive vitamin Dxe2x80x9d is intended to refer to a vitamin D compound or analogue that has been hydroxylated in at least the C-1, C-24 or C-25 position of the molecule and either the compound itself or its metabolites in the case of a prodrug, such as 1xcex1-hydroxyvitamin D2, binds the vitamin D receptor (VDR). For example, xe2x80x9cprodrugsxe2x80x9d are vitamin D compounds which are hydroxylated in the C-1. Such compounds undergo further hydroxylation in vivo and their metabolites bind the VDR.
The term xe2x80x9chypocalcemic vitamin D compoundxe2x80x9d is in reference to active vitamin D analogs which demonstrate hypocalcemic activity, i.e. have low calcemic activity relative to that of 1xcex1,25-dihydroxyvitamin D3, including 24-hydroxyvitamin D compounds, 25-hydroxyvitamin compounds and 1xcex1-hydroxyvitamin compounds.
Also, as used herein, the term xe2x80x9clowerxe2x80x9d as a modifier for alkyl, alkenyl acyl, or cycloalkyl is meant to refer to a straight or branched, saturated or unsaturated hydrocarbon radical having 1 to 4 carbon atoms. Specific examples of such hydrocarbon radicals are methyl, ethyl, propyl, isopropyl, butyl, isobutyl, t-butyl, ethenyl, propenyl, butenyl, isobutenyl, isopropenyl, formyl, acetyl, propionyl, butyryl or cyclopropyl. The term xe2x80x9caromatic acylxe2x80x9d is meant to refer to a unsubstituted or substituted benzoyl group.
As used herein, the term xe2x80x9chydrocarbon moietyxe2x80x9d refers to a lower alkyl, a lower alkenyl, a lower acyl group or a lower cycloalkyl, i.e., a straight or branched, saturated or unsaturated C1-C4 hydrocarbon radial.
The compound in accordance with the present invention is an active hypocalcemic vitamin D compound. The active vitamin D provided is such that the compound has a hydrocarbon moiety at the C-24 position, e.g. a lower alkyl, alkenyl or acyl group as the C-24 position. Further, the active vitamin D in accordance with the present invention may have an unsaturated sidechain, e.g., there is suitably a double bond between C-22 and C-23, between C-25 and C-26 or between C-26 and C-27.
The hypocalcemic hydroxyvitamin D of the present invention suitably has the general formula described in formula (I) 
wherein A1 and A2 each are hydrogen or a carbon-carbon bond, thus forming a double bond between C-22 and C-23; R1 and R2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyl with the proviso that R1 and R2 cannot both be alkenyl, or taken together with the carbon to which they are bonded, form a C3-C8 cyclocarbon ring; R3 is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl or lower cycloalkyl; X1 is hydrogen or hydroxyl, X2 is hydrogen or hydroxyl, or, may be taken with R1 or R2, to constitute a double bond, and X3 is hydrogen or hydroxyl provided that at least one of X1, X2, or X3 is hydroxyl, and Y is a methylene group if the bond to Y is a double bond or is a methyl group or hydrogen if the bond to Y is a single bond.
A 1xcex1-hydroxyvitamin D compound of formula (I) is characterized by the general formula (II): 
wherein A1 and A2 each are hydrogen or a carbon-carbon bond, thus forming a double bond between C-22 and C-23; R1 and R2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyl with the proviso that R1 and R2 cannot both be an alkenyl, or taken together with the carbon to which they are bonded, form a C3-C8 cyclocarbon ring; R3 is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl or lower cycloalkyl; X1 is hydrogen or hydroxyl, X2 is hydrogen or hydroxyl, or, may be taken with R1 or R2, to constitute a double bond, and Y is a methylene group if the bond to Y is a double bond or is a methyl group or hydrogen if the bond to Y is a single bond.
Specifically, 1xcex1-hydroxyvitamin D compounds in accordance with the present invention are characterized by the general formula (III): 
wherein A1 and A2 each are hydrogen or a carbon-carbon bond, thus forming a double bond between C-22 and C-23; R1 and R2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyl with the proviso that R1 and R2 cannot both be an alkenyl, or taken together with the carbon to which they are bonded, form a C3-C8 cyclocarbon ring; R3 is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl or lower cycloalkyl; X1 is hydrogen or hydroxyl, and X2 is hydrogen or hydroxyl, or, may be taken with R1 or R2, to constitute a double bond.
The hypocalcemic hydroxyvitamin D compounds of the present invention are those that have effective antiproliferative and cell differentiation activity (i.e., reversal of malignant transformation), but have a lower tendency or inability to cause hypercalcemia and/or hypercalciuria i.e. they are hypocalcemic compounds that have low calcemic activity relative to that of 1xcex1,25-dihydroxyvitamin D3. In other words, the compounds of the present invention can be administered at dosages that allow them to act as antiproliferative agents and cell differentiation agents when exposed to malignant or other hyperproliferative cells and can reduce hypercalcemia associated with the maligancy. This selectivity and specificity of action makes the hypocalcemic vitamin D compounds useful and preferred antihypercalcemic agents as well as safely inhibiting hyperproliferation and promoting malignant or hyperplastic cell differentiation. The compounds of the present invention, thus, overcome the shortcomings of the known active vitamin D3 compounds described above, and can be considered preferred agents for the control and treatment of malignant diseases such breast, prostate, testicular and colon cancer, as well as other neoplasms such as pancreatic cancer, endometrial cancer, small cell and non-small cell cancer of the lung (including squamous, adneocarcinoma and large cell types), squamous cell of the head and neck, bladder, ovarian and cervical cancers, myeloid and lymphocyltic leukemia, lymphoma, hepatic tumors, medullary thyroid carcinoma, multiple myeloma, melanoma retinoblastoma, and sarcomas of the soft tissue and bone, i.e. neoplasms that express vitamin D receptors.
Suitable hypocalcemic vitamin D compounds in accordance with the present invention include: 1xcex1,24-dihydroxyvitamin D2, 1xcex1,24-dihydroxyvitamin D4, 1xcex1,25-dihydroxyvitamin D2, 1xcex1,25-dihydroxyvitamin D4, 1xcex1-hydroxyvitamin D2, and 1xcex1-hydroxyvitamin D4. Among those compounds of formula (I) that have a chiral center in the sidechain, such as at C-24, it is understood that both epimers (e.g., R and S) and the racemic mixture are within the scope of the present invention.
Thus, the present invention provides a method of treating hypercalcemia associated with malignant cells with an effective amount of a hypocalcemic vitamin D compound. The effective dosage amount on a daily basis per kilogram of body weight of the patient ranges from about 0.01 xcexcg/kg/day to about 2.0 xcexcg/kg/day.
The compounds of formula (I) can be prepared as described, e.g., in U.S. Pat. No. 5,488,120 issued to Knutson et al., U.S. Pat. Nos. 4,670,190 and 4,554,106 issued to DeLuca et al., U.S. Pat. No. 5,486,636 issued to DeLuca et al., and Strugnell et al., 310 Biochem. J. (1995) pp. 233-241, all of which are incorporated herein by reference.
The biopotencies of the compounds of formula (I) have been studied and compared to that of 1xcex1,25-dihydroxyvitamin D3, the active hormonal form of vitamin D and the standard against which all vitamin D compounds and analogues are measured. For example, it has been found that the vitamin D receptor (VDR) binding affinities of the compounds of formula (I), or their active metabolites, are substantially equivalent to (i.e., equal to or up to 3 times weaker than) the affinity of 1xcex1,25-dihydroxyvitamin D3. Such receptor binding affinities are indicative of potent biological activity.
At the same time, it has been found that compounds of formula (I) are significantly less toxic than their corresponding vitamin D3 analogues. For example, in parent co-pending application, Ser. No. 08/265,438, the disclosure of which is incorporated herein by reference, the LD50 for 1xcex1-hydroxyvitamin D4 was found to be 1.0 mg/kg in males and 3.0 mg/kg in females, i.e., substantially less toxic than 1xcex1-hydroxyvitamin D3 (LD50xcx9c0.2 mg/kg). Further, in the parent U.S. Pat. No. 5,403,831, and its grandparent U.S. Pat. No. 5,104,864, both of which are incorporated herein by reference, it has been shown that 1xcex1-hydroxyvitamin D2 has the same biopotency as 1xcex1-hydroxyvitamin D3 and 1xcex125-dihydroxyvitamin D3 but is much less toxic. Even dosages up to 10 xcexcg/day of 1xcex1-hydroxyvitamin D2 in women with postmenopausal osteoporosis elicited only mild hypercalciuria (U.Ca greater than 300 mg/24 hrs), and no marked hypercalcemia (S. Ca greater than 11.0 mg/dL) solely due to 1xcex1-hydroxyvitamin D2 was evident. Additionally, the compound did not adversely affect kidney function, as determined by creatinine clearance and BUN; nor did it increase urinary excretion of hydroxyproline, indicating the absence of any stimulatory effect on bone resorption. Administration of 1xcex1-hydroxyvitamin D2 to healthy adult males in dosages up to 8 xcexcg/day showed no clinically significant hypercalcemia or other adverse effects.
The hypocalcemic vitamin D compounds of the present invention are useful as active compounds in pharmaceutical compositions having reduced side effects and low toxicity as compared with the known analogues of active forms of vitamin D3.
The pharmacologically active compounds of this invention can be processed in accordance with conventional methods of pharmacy to produce medicinal agents for administration to patients, e.g., mammals including humans. For example, the hypocalcemic vitamin D compounds can be employed in admixtures with conventional excipients, e.g., pharmaceutically acceptable carrier substances suitable for enteral (e.g., oral), parenteral or topical application which do not deleteriously react with the active compounds.
Suitable pharmaceutically acceptable carriers include but are not limited to water, salt solutions, alcohols, gum arabic, vegetable oils (e.g., almond oil, corn oil, cottonseed oil, peanut oil, olive oil, coconut oil), mineral oil, fish liver oils, oily esters such as Polysorbate 80, polyethylene glycols, gelatine, carbohydrates (e.g., lactose, amylose or starch), magnesium stearate, talc, silicic acid, viscous paraffin, fatty acid monoglycerides and diglycerides, pentaerythritol fatty acid esters, hydroxy methylcellulose, polyvinyl pyrrolidone, etc.
The pharmaceutical preparations can be sterilized and, if desired, be mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or one or more other active compounds, for example, vitamin D3 and its 1xcex1-hydroxylated metabolites, conjugated estrogens or their equivalents, anti-estrogens, calcitonin, biphosphonates, calcium supplements, cobalamin, pertussis toxin and boron.
For parenteral application, particularly suitable are injectable, sterile solutions, preferably oily or aqueous solution, as well as suspensions, emulsions, or implants, including suppositories. Parenteral administration suitably includes subcutaneous, intramuscular, or intravenous injection, nasopharyngeal or mucosal absorption, or transdermal absorption. Ampoules are convenient unit dosages.
For enteral application, particularly suitable are tablets, dragees, liquids, drops, suppositories, lozenges, powders, or capsules. A syrup, elixir, or the like can be used if a sweetened vehicle is desired.
For topical application, suitable nonsprayable viscous, semi-solid or solid forms can be employed which include a carrier compatible with topical application and having a dynamic viscosity preferably greater than water, for example, mineral oil, almond oil, self-emulsifying beeswax, vegetable oil, white soft paraffin, and propylene glycol. Suitable formulations include, but are not limited to, creams, ointments, lotions, solutions, suspensions, emulsions, powders, liniments, salves, aerosols, transdermal patches, etc., which are, if desired, sterilized or mixed with auxiliary agents, e.g., preservatives, stabilizers, demulsifiers, wetting agents, etc. A cream preparation in accordance with the present invention suitably includes, for example, mixture of water, almond oil, mineral oil and self-emulsifying beeswax; an ointment preparation suitably includes, for example, almond oil and white soft paraffin; and a lotion preparation suitably includes, for example, dry propylene glycol.
Topical preparations of the compound in accordance with the present invention useful for the treatment of skin disorders may also include epithelialization-inducing agents such as retinoids (e.g., vitamin A), chromanols such as vitamin E, xcex2-agonists such as isoproterenol or cyclic adenosine monophosphate (cAMP), anti-inflammatory agents such as corticosteroids (e.g., hydrocortisone or its acetate, or dexamethasone) and keratoplastic agents such as coal tar or anthralin. Effective amounts of such agents are, for example, vitamin A about 0.003 to about 0.3% by weight of the composition; vitamin E about 0.1 to about 10%; isoproterenol about 0.1 to about 2%; cAMP about 0.1 to about 1%; hydrocortisone about 0.25 to about 5%; coal tar about 0.1 to about 20%; and anthralin about 0.05 to about 2%.
For rectal administration, the compound is formed into a pharmaceutical composition containing a suppository base such as cacao oil or other triglycerides. To prolong storage life, the composition advantageously includes an antioxidant such as ascorbic acid, butylated hydroxyanisole or hydroquinone.
For treatment of hypercalcemia associated with maligancy, oral administration of the pharmaceutical compositions of the present invention is preferred. Generally, the compound of this invention is dispensed by unit dosage form comprising about 0.5 xcexcg to about 25 xcexcg in a pharmaceutically acceptable carrier per unit dosage. The dosage of the compound according to this invention generally is about 10 xcexcg to 200 xcexcg/day.
For topical treatment of skin disorders, the dosage of the compound of the present invention in a topical composition generally is about 0.01 xcexcg to about 50 xcexcg per gram of composition. For treatment of skin cancers, the dosage of the hypocalcemic vitamin D compound in a locally applied composition generally is about 0.01 xcexcg to 100 xcexcg per gram composition.
It is noted that dosing of the hypocalcemic compounds in accordance with the present invention can also be done on an episodic basis, in which case higher doses can be used generally about 20 xcexcg to about 200 xcexcg given once every 2 to 7 days. The dose can be given as a single dose or a divided dose in 2 to 5 subdoses, the subdoses given, e.g., one every hour until the total dose is taken.
Those of ordinary skill in the art will readily optimize effective doses and coadministration regimens as determined by good medical practice and the clinical condition of the individual patient. Regardless of the manner of administration, it will be appreciated that the actual preferred amounts of active compound in a specific case will vary according to the efficacy of the specific compound employed, the particular compositions formulated, the mode of application, and the particular situs and organism being treated. For example, the specific dose for a particular patient depends on age, body weight, general state of health, on diet, on the timing and mode of administration, on the rate of excretion, and on medicaments used in combination and the severity of the particular disorder to which the therapy is applied. Dosages for a given host can be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject compounds and of a known agent, such as by means of an appropriate conventional pharmacological protocol.
Further, included within the scope of the present invention is the co-administration of a hypocalcemic vitamin D compound with a anticancer agent, e.g., a cytotoxic agent, Such agents suitably include antimetabolites (e.g., 5-fluoro-uracil, methotrexate, fludarabine), antimicrotubule agents (e.g., vincristine, vinblastine, taxanes such as paclitaxel, docetaxel), an alkylating agent (e.g., cyclophasphamide, melphalan, biochoroethylnitrosurea, hydroxyurea), platinum agents (e.g. cisplatin, carboplatin, oxaliplatin, JM-216, CI-973), anthracyclines (e.g., doxrubicin, daunorubicin), antibiolitics (e.g., mitomycin, idarubicin, adriamycin, daunomycin), topoisomerase inhibitors (e.g., etoposide, camptothecins) or any other antineoplastic agents. (estramustine phosphate, prednimustine). It is anticipated that the hypocalcemic vitamin D compounds used in combination with various anticancer drugs can give rise to a significantly enhanced cytotoxic effect on cancerous cells, thus providing an increased therapeutic effect. Specifically, as a significantly increased growth-inhibitory effect is obtained with the above disclosed combinations utilizing lower concentrations of the anticancer drugs compared to the treatment regimes in which the drugs are used alone, there is the potential to provide therapy wherein adverse side effects associated with the anticancer drugs are considerably reduced than normally observed with the anticancer drugs used alone in larger doses. Possible dose ranges of these co-administered anticancer agents are about 0.1 to 20 mg/kg/day.
The term xe2x80x9cco-administrationxe2x80x9d is meant to refer to any administration route in which two or more agents are administered to a patient or subject. For example, the agents may be administered together, or before or after each other. The agents may be administered by different routes, e.g., one agent may be administered intravenously while the second agent is administered intramuscularly, intravenously or orally. The agents may be administered simultaneously or sequentially, as long as they are given in a manner sufficient to allow both agents to achieve effective concentrations in the body. The agents also may be in an admixture, as, for example, in a single tablet. In sequential administration, one agent may directly follow administration of the other or the agents may be give episodically, i.e., one can be given at one time and the other at a later time, typically within a week. An example of a suitable co-administration regimen is where a hypocalcemic vitamin D compound is administered from 0.5 to 7 days prior to administration of a cytotoxic agent.
Also included within the scope of the present invention is the co-administration of effective dosages of the analogue of formula (I) in conjunction with administration of hormones or other agents, e.g., estrogens, which are known to ameliorate bone diseases or disorders. As noted above, prostate cancer often metastasizes to bone, causing bone loss and associated pain. Such bone agents may include conjugated estrogens or their equivalents, calcitonin, bisphosphonates, calcium supplements, cobalamin, pertussis toxin and boron. It is contemplated that these bone agents also have an antihypercalcemic effect and may enhance the treatment of malignancy-associated hypercalcemia. Possible dose ranges for these co-administered bone agents are provided in Table 1.
Antiestrogens, such as Tamoxifen(trademark), are also known bone agents and may be suitably used in conjunction with the hypocalcemic hydroxyvitamin D compounds of the present invention.
The present invention is further explained by the following examples which should not be construed by way of limiting the scope of the present invention.